Coagulation PPT- Josh

Question 1

Layers of vessel

outer to inner

Answer 1

• Tunica Adventitia
• Tunica media
• Tunica Intima

Question 2

Name the coag factors

• I
• II
• III
• IV
• V
• VII
• VIII
• IX
• X
• XI
• XII
• XIII

Answer 2

1. fibrinogen
2. Prothrombin
3. Tissue factor
4. Calcium
5. Proaccelerator
6. nothing
7. Procovertin
8. Antihemophiliac factor (and vWf)
9. Christmas Factor
10. Stuart-power factor
11. Plasma thromboplastin
12. Hageman factor
13. Fibrin-stabalizing factor

Question 3

Lab Testing:

What is normal PT/INR?

Answer 3

11-12.5 sec

0.8-1.1

Question 4

Lab Testing:

What pathways does PT/INR measure

Answer 4

both common & Extrensic

Question 5

Lab Testing:

what factors does PT/INR measure

Answer 5

III, VII (extrensic)

X, V, II,I (common)

Question 6

Lab Testing:

normal aPTT

Answer 6

30-40 sec

Question 7

Lab Testing:

what pathways does aPTT monitor

Answer 7

both common and Intrinsic

Question 8

Lab Testing:

so what factors does aPTT monitor

Answer 8

XII, XI, IX, VIII (INTRENSIC)

X, V, II, I (COMMON)

Question 9

Lab Testing:

what are normal values for Fibrinogen?

Answer 9

200-400 mg/dL

Question 10

Lab Testing:

what pathway does fibrinogen monitor

Answer 10

common pathway

Question 11

Lab Testing:

what factors are monitored w/ fibrinogen

Answer 11

X, V, II, I

Question 12

Lab Testing:

A fibrinogen level of what is associated w/spontaneous bleeding

Answer 12

< 100 mg/dL

Question 13

Lab Testing:

what is normal fibrin split products

Answer 13

< 10 mg/L

Question 14

Lab Testing:

Fibrin split products is a direct indication of what?

Answer 14

direct indication of activity of fibrinolytic activity

Question 15

Lab Testing:

what is normal Bleeding time

Answer 15

1-9 min

Question 16

Lab Testing:

what does bleeding time evaluate

Answer 16

platelet function/quality and vascular constriction capability

Question 17

Lab Testing:

Bleeding time does not provide accurate _____ count

Answer 17

platelet count

Question 18

Lab Testing:

what is a wider-encompassing test of clot formation, stability, and lysis

Answer 18

Thromboelastography

(TEG)

Question 19

TEG:

name the main components of the TEG

Answer 19

1. Coagulation
2. fibrinolysis
3. Clotting time
4. clot kinetics
5. Clot strength
6. Lysis time

Question 20

TEG pic

Answer 20

Question 21

during the fluid resucitation or massive blood transfusion, that is ___ fluid volume in 24 hrs, or ___ fluid volume in 3 hours, causes coagulation factors and platelets to become significantly diluted

Answer 21

1

1/2

Question 22

what is the depletion of platelets secondary to markedly increased platelet consumption from coagulation pathway activity?

Answer 22

thrombocytopenia

Question 23

Thrombocytopenia may lead to microthrombi, resulting in purpura called what?

Answer 23

thrombocytopenic purpura

Question 24

what can occur if the entire coagulation pathway is activated

Answer 24

DIC

Question 25

What is platelet levels with DIC for MILD MODERATE SEVERE

Answer 25

* MILD- 70,000-150,000 * MODERATE- 40,000-70,000 * SEVERE- 20,000-40,000

Question 26

thrombocytopenia: vascular occlusion by thrombi formation is unusual w/DIC, and the typical manifestation is what?

Answer 26

hemorrhage

Question 27

thrombocytopenia: HELLP follows the same pathway as DIC, but is also combined with what?

Answer 27

RBC hemolysis and elevated liver enzymes

Question 28

DIC: what is the only effective treatment?

Answer 28

treatment of teh underlying cause

Question 29

DIC: what is supportive therapy

Answer 29

Plasma and Platelet transfusions

Question 30

What are 2 types of Autoimmune Coagulopathy

Answer 30

* Posttransfusion Purpura * Drug induced Autoimmune Thrombocytopenic Purpura

Question 31

Autoimmune what causes posttranfusion purpura

Answer 31

Exposure to blood products or some drugs that may induce antibody formation

Question 32

Autoimmune Coagulopathy: in DIATP the drugs can act what?

Answer 32

a binding agent for the antibodies to adhere to platelets

Question 33

Autoimmune Coagulopathy: Heparin-Induced Thrombocytopenia What are the 2 types

Answer 33

* Tyoe I- nonimmune HIT- Seen on 1st day of heparim therapy (transient an dclinically insignificant * Type II- Immune mediated HIT- formation of antibodies to heparin-platelet factor 4 complex

Question 34

Autoimmune Coagulopathy: HIT tyoe 2 occurs when

Answer 34

5-10 days after heparin use and can been seen if heparin therapy is restarted w/in 20 days of previous exposure

Question 35

Autoimmune Coagulopathy: Anesthestic management

Answer 35

* Poss platelet transfusion * D/C precipitating drug * Hold Warfarin and oral contraceptives * Delay CV sx

Question 36

Autoimmune Coagulopathy: if thrombotic even occurs, administer what?

Answer 36

direct thrombin inhibitor | (argatroban and bivalirudin)

Question 37

Coagulopathy in SIRS: this is caused by what?

Answer 37

arises w/ the initiation of the imflammatory responses secondary to infection and decreased blood flow secondary to vasodilation (AKA coag cascade activated)

Question 38

Coagulopathy in SIRS: what is management ?

Answer 38

* keep Hgb 7-9 * FFP for sx * Keep platelets \> 50,000 *

Question 39

Coagulopathy: Preop interview

Answer 39

* ? hx of bleeding * ? hx of bleeding gims w/ dental sx * ? hx of liver insufficiency or malnutrition * Coag workup * Discuss transfusion possibility